Digital Access and Primary Care Use in Chronic Disease Management: Preliminary Evidence From Three Caribbean Cities in Colombia
Mario de la Puente, Hernán Guzmán, Denis Adriana González Sánchez, Anderson Domínguez, Juan LambyIntroduction
Chronic disease management depends on sustained interaction with primary care services, yet these interactions may be shaped by digital inequalities in urban middle-income settings. This study examines whether household digital access is associated with differences in primary care utilization and hospitalization outcomes among adults with chronic diseases in three Caribbean cities of Colombia: Barranquilla, Cartagena, and Santa Marta.
Methods
This study used a quantitative, observational, cross-sectional, and exploratory design based on secondary anonymized data from national household surveys, SISPRO administrative health records, and national ICT indicators. The analytical sample included adults aged 18 years and older living in urban households in Barranquilla, Cartagena, and Santa Marta who had at least one chronic disease identified through survey or administrative records and had complete information for the dependent variable and all covariates included in the multivariable models. Individuals younger than 18 years, residents of rural areas, persons without evidence of chronic disease, and observations with missing data in key analytical variables were excluded. Descriptive comparisons were combined with binary logistic regression models including household internet access, age, gender, education, income quintile, insurance regime, and city fixed effects, and a probit model was estimated as a robustness check.
Results
Descriptive findings show that individuals living in households with internet access reported more primary care visits than those without access. Across the pooled sample, predicted probabilities of hospitalization were lower among individuals with household internet access, with the largest difference observed in Santa Marta. The robustness analysis using a probit specification confirmed the same negative association between household internet access and hospitalization probability.
Conclusion
The findings provide preliminary evidence that household digital access is associated with greater primary care utilization and lower hospitalization risk among adults with chronic diseases in the three cities studied. Although the cross-sectional design does not allow causal inference, the results suggest that digital inclusion may be a relevant complementary component of primary care-centered strategies for chronic disease management in urban middle-income contexts.